Abstract
Atrial fibrillation (AF) is a prevalent condition particularly amongst the elderly, which contributes to both morbidity and mortality. The burden of disease has lead to significant increases in health care utilization and cost in recent years. Treatment of Atrial fibrillation consists of either a rate or rhythm control strategy. Rhythm control is achieved using medical management and/or catheter ablation. In spite of major strides in catheter ablation, this procedure remains a second line treatment of AF. Anti-arrhythmic medications represent the main treatment modality for the maintenance of sinus rhythm. Amiodarone has been used for decades because of its efficacy and lack of pro-arrhythmia despite numerous extracardiac side effects. Novel agents such as Dronedarone were designed to emulate Amiodarone without the extra-cardiac side effects. Unfortunately recent trials have raised concerns for the safety of this medication in certain patients. Other agents such as Vernakalant and Ranolazine are in development that promise to be more atrial selective in their action, thereby potentially avoiding pro-arrhythmia and heart failure side effects. It remains to be seen however if one or more of these agents achieves the required high efficacy and safety threshold. This review summarizes the main anti-arrhythmic clinical trials, early phase trials involving novel agents and examines the conflicting data relating to Dronedarone.
Keywords: Atrial fibrillation, anti-arrhythmic drugs, atrial selectivity, dronedarone, novel agents, ranolazine, vernakalant
Current Cardiology Reviews
Title:Novel Anti-arrhythmic Medications in the Treatment of Atrial Fibrillation
Volume: 8 Issue: 4
Author(s): Pradyot Saklani and Allan Skanes
Affiliation:
Keywords: Atrial fibrillation, anti-arrhythmic drugs, atrial selectivity, dronedarone, novel agents, ranolazine, vernakalant
Abstract: Atrial fibrillation (AF) is a prevalent condition particularly amongst the elderly, which contributes to both morbidity and mortality. The burden of disease has lead to significant increases in health care utilization and cost in recent years. Treatment of Atrial fibrillation consists of either a rate or rhythm control strategy. Rhythm control is achieved using medical management and/or catheter ablation. In spite of major strides in catheter ablation, this procedure remains a second line treatment of AF. Anti-arrhythmic medications represent the main treatment modality for the maintenance of sinus rhythm. Amiodarone has been used for decades because of its efficacy and lack of pro-arrhythmia despite numerous extracardiac side effects. Novel agents such as Dronedarone were designed to emulate Amiodarone without the extra-cardiac side effects. Unfortunately recent trials have raised concerns for the safety of this medication in certain patients. Other agents such as Vernakalant and Ranolazine are in development that promise to be more atrial selective in their action, thereby potentially avoiding pro-arrhythmia and heart failure side effects. It remains to be seen however if one or more of these agents achieves the required high efficacy and safety threshold. This review summarizes the main anti-arrhythmic clinical trials, early phase trials involving novel agents and examines the conflicting data relating to Dronedarone.
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Cite this article as:
Saklani Pradyot and Skanes Allan, Novel Anti-arrhythmic Medications in the Treatment of Atrial Fibrillation, Current Cardiology Reviews 2012; 8 (4) . https://dx.doi.org/10.2174/157340312803760785
DOI https://dx.doi.org/10.2174/157340312803760785 |
Print ISSN 1573-403X |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6557 |
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